You have a very small cancer in the breast, or there is something in your breast that may be one. The plan is to take out the diseased part of the breast with a clear rim of healthy breast. At the same time glands will be taken from your armpit (axilla). The glands are small clusters of cells that are connected to tiny draining pipes in the breast and axilla, called lymphatics. When cancer 'travels' and spreads through the lymphatics, the glands will be affected and will get bigger.
This is what is meant by a wide excision and axillary sample. Sometimes all the glands are taken from your armpit. This is called an axillary clearance. The two pieces of tissue are looked at under the microscope in the laboratory to see if the lesion in your breast is cancer or not and also to see if the cancer has spread to the glands of your axilla. Future treatment will be based on this important information.
Q. What is the problem ?
You have a very small cancer in the breast, or there is something in your breast which may be one.
The plan is to take out the diseased part of the breast with a clear rim of healthy breast. At the same time we will take out a gland or two from your armpit (axilla axe-ill-a). This is what we mean by a wide excision and axillary sample.
We send the two pieces of tissue to be looked at under the microscope.
If the breast tissue is free from any cancer, no more treatment is needed.
If there is a small breast cancer, we need to check two things. First, is there a wide enough rim of breast tissue around the tumour for safety? Second, is the rim of breast tissue itself quite healthy? Sometimes the breast tissue is unstable and may turn into another cancer in the years to come.
If the rim of breast tissue is healthy, you need no more operations, but X-ray treatment to the breast is then the next step. If you are fifty years old or more, taking the drug Tamoxifen (tam-ox-ee-fen) is sensible.
If the rim of breast tissue is not clear, or is not stable, you would need to think about having more surgery. This would mean having more breast tissue taken out, or even having the whole breast taken away. We will talk to you about this.
If the glands in the armpit are free from cancer cells, you do not need any more treatment.
If there are cancer cells in the glands, it is sensible to have x-ray treatment to the glands in the armpit, around the collar bone and behind the breast bone. If you are in your 40's or younger it is sensible to think about having drug treatment (chemotherapy key-mo-ther-appy) as well. We will go into this in detail with you.
Before your Operation
You will be admitted on either the day of the operation or the day before.
You will be asked to sign a consent form if this has not already been done.
You may be asked to wear TED stockings. These help to prevent blood clots in your legs.
You may receive a small injection which also helps to prevent blood clots. This is usually given twice a day.
You will be asked to be nil by mouth for a few hours before your operation. You will be advised of when this will start.
After the Operation
You will be able to eat and drink as soon as you feel able to.
You will be able to get out of bed, when you feel well enough.
You may have one or two drains in place, these may be in for up to a few days.
Your dressings will be removed after 2-3 days.
You will be given more information before going home.
You will receive the results of the operation as soon as possible. This will mean coming to the Out Patient Clinic. An appointment will be arranged for you.
You will probably be referred to Dr Burt, Consultant Clinical Oncologist, who is based at the Christie Hospital, in Manchester.
The Operation
Wide Local Excision means that the breast lump is going to be removed along with some tissue surrounding it that looks healthy. This is then analysed after your operation.
The doctors will then be able to tell you if they feel enough tissue has been removed.
Occasionally, some people need to have a further operation if the disease has extended beyond the tissue that has been removed the first time.
You may also be advised to have some or all of your lymph glands from your arm pit removed. This may be done with just the one incision in your breast or with a second one under your arm.
Risks
These risks include having an anaesthetic and wound infection. These will be discussed with you at the pre-operative assessment clinic, on the ward or with your own doctor.You will already have been advised about the possibility of surgery to your armpit. This will be either an axillary sample or clearance which is explained below.
Complications
Complications are minimal and seldom serious.
If you think that all is not well, please ask the nurses or doctors.
Bruising may be troublesome. Occasionally some old blood collects under the wound, but this can easily be removed.
Occasionally the wound edge does not heal well in places. This always settles down but may take 2 or 3 weeks to do so.
Infection is a rare problem and settles down with antibiotics in a week or two.
Aches and twinges may be felt in the wounds for 4 to 6 weeks. The wound in your armpit is smaller than the one in your breasts, but may be much more uncomfortable.
Occasionally there is a numb patch in the skin of the armpit and down the inside of the upper arm. This patch slowly lessens in size but may always be present.
FAQs
Q. Will it hurt ?
There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant.
There will be some discomfort when you are at home the next day.
By the end of one week the wound should be virtually pain free.
Q. What does the operation consist of ?
You will have a general anaesthetic and be completely asleep. You will not feel any pain during anaesthetic.
We make a cut in the skin of the breast over the swelling. Sometimes we take out a piece of skin. We make the cut in one of the skin lines which run around the breast to give the best healing. We take out the swelling or problem area in the breast with a rim of breast tissue. We can often take out a gland from the armpit through this cut. If the first cut is too far from the armpit, we make a second cut there.
We put a fine plastic drainage tube in the wound. We bring this drain through the skin usually in the skin fold under the breast. We fix a plastic bottle to the end of the drain tube to collect any ooze of blood into the wound. We close the skin cut(s) with stitches under the skin. These will melt away. They do not need to be taken out.
We send the tissue to the laboratory. There it is looked at under a microscope to find out what is going on. It takes about one week to get an answer.
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